Headlines about "Medicare and Medicaid"
Gathered from the web by the editors at BenefitsLink.com.
[Opinion] How to Get the Country to Solvency on Entitlements
Excerpt: "In 2013, when President Mitch Daniels, former Indiana governor, is counting his blessings, at the top of his list will be the name of his vice president: Paul Ryan. The former congressman from Wisconsin will have come to office with ideas for steering the federal government to solvency." (George F. Will via The Washington Post; free registration required)
[Official Guidance] Text (MS Word Document) of Model Notice for Employers to Use Regarding Eligibility for Premium Assistance Under Medicaid or CHIP
3 pages. Excerpt: "If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available." (Employee Benefits Security Administration)
[Guidance Overview] DOL Publishes Model Employer CHIP Notice
Excerpt: "CHIPRA requires employers offering group health plans to notify all employees of their potential CHIPRA rights to receive premium assistance under a state's Medicaid or CHIP program. Employers may combine this notice with other information (e.g., open enrollment materials) as long as it goes to the entire employee population, not just participants. The requirement applies to employers that offer medical care benefits in any of 40 states that currently provide premium assistance." (Infinisource)
[Official Guidance] Model Notice from DOL for Employers to Use Regarding Eligibility: Premium Assistance Under Medicaid or the Children's Health Insurance Program (PDF)
4 pages. Excerpt: "On February 4, 2009, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Pub. L. 111?3). CHIPRA includes a requirement that the Departments of Labor and Health and Human Services develop a model notice for employers to use to inform employees of potential opportunities currently available in the State in which the employee resides for group health plan premium assistance under Medicaid and the Children's Health Insurance Program (CHIP). The Department of Labor (Department) is required to provide the model notice to employers within one year of CHIPRA's enactment. This document announces the availability of a Model Employer CHIP Notice." (Employee Benefits Security Administration)
Additional Information from CBO on Effect of Patient Protection and Affordable Care Act on Hospital Insurance Trust Fund (PDF)
4 pages. Excerpt: "This letter responds to questions you posed about the Congressional Budget Office's (CBO's) analysis of the effects of H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as passed by the Senate on December 24. In particular, you asked for clarification on several issues regarding the effect of the legislation on the Hospital Insurance (HI) trust fund, from which Medicare Part A benefits are paid." (U.S. Congressional Budget Office)
[Guidance Overview] CMS Update of Creditable Coverage and Late Enrollment Penalty Guidance
Excerpt: "The recent changes by CMS reflect a tightening of the procedures that apply in determining creditable coverage and the Part D plan sponsor's obligation to collect the [late enrollment penalty]." (Deloitte via BenefitsLink.com)
[Guidance Overview] Deadline Approaches for Submission of Creditable Coverage Disclosures to CMS (PDF)
Excerpt: "Group health plan sponsors that provide prescription drug coverage to Medicare Part D eligible individuals must annually disclose to the Centers for Medicare & Medicaid Services (CMS) whether such coverage qualifies as creditable or non-creditable. All plan sponsors that provide prescription drug coverage are required to make this disclosure, even if they do not make coverage available to retirees. Calendar year plans must submit this year's disclosure to CMS by March 1, 2010." (Buck Consultants)
Medicare Traps for the Still-Working 65-Year-Old
Excerpt: "Making the transition from an employer health plan to Medicare by way of COBRA coverage can be problematic. Each decision point along the way involves is subject to very specific deadlines. Miss one and you may find yourself in health insurance limbo." (Morningstar)
[Guidance Overview] CMS Update of Creditable Coverage and Late Enrollment Penalty Guidance in Medicare Prescription Drug Benefit Manual
Excerpt: "EBIA Comment: Most of the guidance is aimed at Part D plan sponsors, not at group health plan sponsors. However, both groups must comply with CMS standards. Group health plan sponsors must provide disclosure notices to help Part D eligible individuals make informed decisions about whether to enroll in a Part D plan. Part D plan sponsors must enroll individuals based on various criteria, including creditable coverage information from group health plan sponsors. Both groups must ensure that creditable coverage information is accurate, which should reduce the imposition of unnecessary [late enrollment penalties]." (Employee Benefits Institute of America)
Retiree Health Benefit Trends Among the Medicare-Eligible Population (PDF)
Excerpt: "This article examines the prevalence of retiree health benefits among Medicare-eligible retirees. It discusses the percentage of retirees with employment-based retiree health benefits over the 1994?2008 period. It also examines the trend for individually purchased coverage as a supplement to Medicare." (Employee Benefit Research Institute)
Medicare Part D: Taking Another Look at Employee Group Waiver Plans for Tax-Exempt Plan Sponsors (PDF)
2 pages. (Milliman)
Employers Warn of Cuts to Benefits Due to Tax Treatment of Medicare Part D Benefits
Excerpt: "Some of the biggest employers in the U.S. are warning that a provision in the Senate's proposed health-care overhaul could lead to cuts in retiree benefits and a sharp reduction in reported earnings next year. Companies including Boeing Co., Deere & Co., MetLife Inc. and Xerox Corp. plan to lobby Democratic leaders to drop the provision, which would change the tax status of payments for retiree health benefits." (The Wall Street Journal)
Medicare Part D 2010 Data Spotlight: A Comparison of PDPs Offering Basic and Enhanced Benefits
Excerpt: "Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an actuarially equivalent benefit design. Plan sponsors can also offer plans with enhanced drug benefits. Enhanced plans are required to have a greater actuarial value than basic plans, but plans vary in the ways in which they improve coverage. This Part D Data Spotlight examines key differences between basic and enhanced Medicare stand-alone prescription drug plans (PDPs), including monthly premiums, cost sharing, and gap coverage." (Kaiser Family Foundation)
[Guidance Overview] Year-End Reminders for Health and Welfare Plans: 2009
Excerpt: "As an eventful 2009 draws to a close, this Update highlights federal developments affecting health and welfare plans, including new restrictions on the use of genetic information, coverage expansions, the COBRA subsidy program, new rights for military families, parity requirements for mental health coverage, Medicare secondary payer reporting, and changes in HIPAA privacy and security provisions made by the HITECH Act." (Mercer LLC)
Senate Majority Leader Harry Reid Says Medicare Part D 'Doughnut Hole' Will Be Closed
Excerpt: "The House health reform bill closes the hole, but 'the Senate, worried about the cost of its health care bill, only partially filled the gap in its bill.' Reid said the hole would be closed in conference committee . . . ." (Kaiser Family Foundation)
[Opinion] Financial Executives International Writes Congress on Tax Treatment of Medicare Part D Subsidy
Excerpt: "On Dec. 8, 2009 Financial Executives International wrote to Senate leadership on the proposed change to the tax treatment of the Medicare Part D subsidy. The letter, signed by FEI President and Chief Executive Officer Marie N. Hollein, was sent to Senate Majority Leader Harry Reid (D-Nev.) and Senate Minority Leader Mitch McConnell (R-Ky.)" (Financial Executives International)
Extending Medicare: Effects on Employers and Employees
Excerpt: "The recently proposed expansion of Medicare to cover individuals between the ages of 55 and 64 if they purchase the coverage could forge a final compromise Democrats are seeking in the Patient Protection and Affordable Care Act (H.R. 3590). So let's take a look at employees and employer-based plans in light of this proposal." (Wolters Kluwer)
[Opinion] American Benefits Council/AFL-CIO Joint Letter to Senate Majority Leader Regarding Taxation of Retiree Drug Subsidy (PDF)
2 pages. Excerpt: "Section 9012 would cease the current tax excludability of the 28 percent subsidy provided to employers who continue to provide prescription drug coverage to their retirees. If this provision becomes law, it will be highly destabilizing for retirees who rely upon employer sponsored drug coverage, it will impose a dramatic and immediate impact on company financial statements, and it will not raise the estimated federal revenue attributed to this change in tax law." (American Benefits Council)
[Opinion] Joint CFO Letter to Congress Regarding Taxation of Retiree Drug Subsidy (PDF)
2 pages. Excerpt: "Of significant concern to us in both the House and Senate bills are the provisions that would change the tax treatment of the Medicare Part D Retiree Drug Subsidy (RDS) Program to generate revenue to help offset the cost of health care reform." (American Benefits Council)
Medicare 'Buy-In': A Bargain or Burden?
Excerpt: "Seeking to break a deadlock between liberals and moderates over a proposed new government-run insurance plan to compete with private plans, Senate Majority Leader Harry Reid and other Democrats now want to expand eligibility for Medicare. Details of the plan remain secret pending analysis by the Congressional Budget Office, which will project its cost to those who might be eligible and the federal government. People ages 55 to 64 who are uninsured or paying high premiums in the individual market likely would be eligible. Most of those with employer-provided coverage would not." (USA TODAY)
Mini-Medicare Proposal Could Solve Municipal Retiree Benefits Problems As Police, Fire and Teachers Could Use Medicare at 55, Cutting Localities' Costs
Excerpt: "A group of Democrats in the Senate are working on a health-care reform compromise that contains a feature of keen interest to state and local governments -- expanded access to Medicare benefits for American retirees and unemployed workers over age 55. This proposal gained renewed interest as a trade-off or alternative for the so-called public option which has become a possible deal-breaker." (Governing.com)
[Guidance Overview] 2010 Medicare Premiums, Deductibles and Coinsurance
Excerpt: "Plan sponsors that pay the Medicare Part B premium or deductible should carefully review their plan documents and communications to assure that they are accurately stating the amount that the plan intends to pay. For example, plans that simply promise to pay the 'Part B deductible' may want to set that payment at a firm amount or maximum." (Segal Company)
Pressure Mounts for Special Process in Congress to Address Federal Debt, Including Health Care and Retirement Entitlements
Excerpt: "Noting that the regular order in Congress will not be able to deal with the increasing federal debt load, which is driven largely by entitlement programs such as Social Security and Medicare, Senate Budget Committee chair Kent Conrad (N.D.) concluded in a committee hearing on November 10 that a 'special process' is needed to compel legislators to fix the nation's fiscal problems." (Wolters Kluwer)
Aging and Health: The Challenges of Entitlement Growth (PDF)
November 2009. CBO Director Doug Elmendorf's presentation to the Association for Public Policy Analysis and Management. 16 pages. (U.S. Congressional Budget Office)
A Step-by-Step Guide to the Medicare 2010 Drug Plan Finder
Excerpt: "Looking for a Medicare Part D drug plan that will cost you the least in 2010 and cover all or most of your prescription drugs? This guide provides a direct route to that information by taking you step by step through Medicare's Prescription Drug Plan Finder, a useful online tool that allows you to compare many drug plans head to head to find your best deal. The plan finder does the math for you, so that you can see your likely out-of-pocket costs -- premium, deductible and copays for the specific drugs you use -- throughout the year." (AARP)
Medicare Part D and the Financial Protection of the Elderly
Excerpt: "We examine the impact of the expansion of public prescription prescription-drug insurance coverage from Medicare Part D has had on the elderly and find evidence of substantial crowd-out. Using detailed data from the 2002-6 waves of the Medical Expenditure Panel Survey (MEPS), we estimate that the extension of Part D benefits resulted in 75% crowd-out of prescription drug insurance coverage and 33%-50% crowd-out of prescription drug expenditures of those 65 and older. Part D is associated with relatively small reductions in out-of-pocket spending. This suggests that the welfare gain from protecting the elderly from out-of-pocket spending risk through Part D has been small." (Center for Retirement Research at Boston College)
[Guidance Overview] 2010 Medicare Premiums, Deductibles and Coinsurance
Excerpt: "Plan sponsors that pay the Medicare Part B premium or deductible should carefully review their plan documents and communications to assure that they are accurately stating the amount that the plan intends to pay. For example, plans that simply promise to pay the 'Part B deductible' may want to set that payment at a firm amount or maximum. If the plan is vague regarding the amount of the Part B premium that the plan will pay, costs could inadvertently increase as the Part B premium rises, and could rise substantially if the plan has participants subject to income-based indexing." (The Segal Group, Inc.)
[Guidance Overview] Medicare Part D Notices to Eligible Individuals Due Nov. 15 (PDF)
14 pages. Includes links to Model Individual Creditable Coverage Disclosure Notice and Model Individual Non-Creditable Coverage Disclosure Notice to be used in 2009. (Warner Norcross & Judd)
CMS Issues 2010 Medicare Premium, Deductible and Coinsurance Amounts
Excerpt: "The Centers for Medicare and Medicaid Services has released 2010 premiums, deductibles and other cost-sharing amounts for Medicare Parts A and B. The standard Part B monthly premium increases to $110.50, and the annual Part B deductible increases to $155. The Part A deductible will increase to $1,100 in 2010, while daily hospital cost-sharing amounts will increase by $8 or $16, depending on length of stay. However, a rarely applied rule will keep premiums the same for nearly three-quarters of recipients." (Mercer LLC)
[Guidance Overview] Remember to Distribute Annual Medicare Part D Notices by November 15, 2009
Excerpt: "Just a reminder that it's time once again to make sure that you have distributed the Notice of Creditable Coverage required under Medicare Part D, which informs participants whether the prescription drug coverage offered under your health plan constitutes creditable or noncreditable coverage. Once again, the Centers for Medicare and Medicaid Services (CMS) has issued updated forms that you may use to provide this notice. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. The only employers exempt from this notice requirement are those that establish their own Part D plan or who contract with a Part D plan." (Warner Norcross & Judd LLP)
[Guidance Overview] CMS Proposes Policy and Technical Changes to Medicare Part D Regulations, Including COB and MSP Provisions
Excerpt: "CMS has proposed policy and technical changes to the regulations for the Medicare Part D program that are intended to clarify participation requirements, strengthen beneficiary protections, improve payment rules, and implement new policy. As discussed below, some of the proposed changes affect group health plan sponsors that provide prescription drug coverage for Part D eligible individuals (including active employees, disabled employees, COBRA participants, retirees, and their covered spouses and dependents). In particular, changes have been proposed to the regulations on MSP procedures for coordination of benefits (COB) between Part D plans and other providers of prescription drug coverage (including group health plan sponsors). For example, the regulations would include a requirement for Part D plans to report credible new or changed primary payer information to the CMS Coordination of Benefits Contractor." (Employee Benefits Institute of America)
[Guidance Overview] 2010 Cost-of-Living Adjustments for Medicare (PDF)
2 pages. Note the paragraph on page 2 regarding employer action to be taken. (Milliman)
[Guidance Overview] Key 2010 Medicare Values (PDF)
2 pages. Excerpt: "This For Your Information provides key 2010 Medicare values just released by the Centers for Medicare and Medicaid Services, including the income-adjusted Medicare Part B premiums as prescribed by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)." (Buck Consultants)
Basic Medicare Premium to Rise 15% Next Year
Excerpt: "The basic Medicare premium will shoot up next year by 15 percent, to $110.50 a month, federal officials said Monday. The increase means that monthly premiums would top $100 for the first time, a stark indication of the rise in medical costs that is driving the debate in Congress about a broad overhaul of the health care system." (The New York Times; free registration required)
[Opinion] What Exactly Does It Mean to Finance Retirement?
Excerpt: "Let's talk really macro policy for a bit. 401(k) plans and DB plans are (private) vehicles for financing retirement income. Social Security is a public vehicle for the same purpose. So, in fact, is Medicare. As people age, medical costs make up a greater and greater share of the cost of living. For many, in the end, medical costs are all you spend money on. So, one pretty useful way to think about Medicare is as another (public) vehicle for financing retirement." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Chart of 415, Etc., Limits Updated for News Release IR-2009-94
The chart of maximum limits subject to inflation indexing at Carol V. Calhoun's employee benefits site has now been amended to include the newly announced 2010 limits. Among other things, the chart shows limits under sections 415, 403(b), 401(k), and 457, as well as the Social Security wage base and Social Security and Medicare tax rates, for 1996-2010. (Calhoun Law Group, P.C.)
Regulation of Private Health Insurance Markets: Lessons from Enrollment, Plan Type Choice, and Adverse Selection in Medicare Part D
Excerpt: "We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets that control adverse selection and assure adequate access and coverage. We model Part D enrollment and plan choice assuming a discrete dynamic decision process that maximizes life-cycle expected utility, and perform counterfactual policy simulations of the effect of market design on participation and plan viability. Our model correctly predicts high Part D enrollment rates among the currently healthy, but also strong adverse selection in choice of level of coverage. We analyze alternative designs that preserve plan variety." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
Medicare Bite Tied to Roth Would Be Temporary
Excerpt: "Yes, converting to a Roth could result in paying higher Medicare premiums, but the increase will likely be temporary. The key: If you are a Medicare beneficiary, or about to become one, it is smart to calculate whether the additional income created by a conversion could increase your Part B premiums, as well as your tax bill. Then, with that information in hand, you can make an informed decision about whether a Roth conversion makes sense for you." (The Wall Street Journal)
[Guidance Overview] CMS's Proposed Changes in Disclosure to CMS Form Instructions and Revises Guidance on Disclosure to Part D Eligible Individuals
Excerpt: "EBIA Comment: The changes to the creditable coverage disclosure items . . . are merely clarifying, not substantive. But those who are responsible for providing the required disclosures to CMS and to Medicare Part D eligible individuals should pay attention to these changes. The deletion of the mail-order provision is welcome. Since plans are not required to offer mail-order prescription drug coverage to meet the safe harbor, CMS may have dropped that provision just to avoid confusion. Having clarity in the safe harbor requirements is important: Plans that do not meet those requirements must make an actuarial determination of whether their prescription drug coverage is creditable." (Employee Benefits Institute of America)
[Opinion] 'Mini Medicare' Reform Could Cut Retirement Health Benefit Costs for Public Workers
Excerpt: "Today's Medicare benefits are unaffordable and unsustainable. To achieve actuarial balance, we need to both raise the payroll tax and raise the eligibility age for those we subsidize. Both reforms are achievable and must be joined at the hip to receive bipartisan support -- while at the same time providing a competitive alternative in the health insurance marketplace that 'bends the cost curve' and thus reduces state and local government retiree health care costs." (Governing.com)
[Guidance Overview] Deadline for Medicare Part D Creditable Coverage Notices Approaches (PDF)
2 pages. Excerpt: "Medicare Part D notices of creditable or non-creditable coverage must be provided to Medicare-eligible individuals prior to November 15 of each year. Many employers satisfy this requirement by including the notice in enrollment materials or in separate mailings in the fall. In preparing materials for distribution this fall, employers should be aware of revised model notices provided by the Centers for Medicare & Medicaid Services (CMS)." (Buck Consultants)
[Guidance Overview] Compliance with Mandatory Reporting Requirements Under Medicare, Medicaid and SCHIP Extension Act of 2007 (PDF)
Excerpt: "The Medicare, Medicaid and SCHIP Extension Act of 2007 ('MMSEA') took effect July 1, 2009. One of the purposes of MMSEA is to allow the federal government to recover payments made under Medicare when Medicareincorrectly acted as a primary payer or when a Medicare beneficiary receives payments from both an insurer and Medicare for the same injury. To that end, MMSEA requires group health plan arrangements ('GHPs' ) and liability insurers, no-fault insurers, workers' compensation insurers, and self-insurers (collectively, 'non-GHPs') to report any settlement, award, judgment, or other payment that they make involving a Medicare beneficiary to the Centers for Medicare and Medicaid Services ('CMS'), the federal agency within the U.S. Department of Health and Human Services that is responsible for administering Medicare." (Porter Wright Morris & Arthur LLP)
[Guidance Overview] CMS Revises HICN/SSN Collection Form Used for Mandatory Reporting Purposes
Excerpt: "EBIA Comment: Issuance of the revised guidance highlights CMS's commitment to getting the HICN/SSNs. Most of the changes were likely intended to make it easier for [responsible reporting entities (RREs)], active covered individuals, their spouses and family members to provide CMS with the necessary information. It is not clear why the reference to 'parent' was dropped from the revised guidance. Since the term had previously appeared in some categories but not others, the deletion may have been for reasons of consistency and not substance. But Medicare regulations do provide that 'family members may include a spouse (including a divorced or common-law spouse), a natural, adopted, foster, or stepchild, a parent, or a sibling.'" (Employee Benefits Institute of America)
2010 Medicare Part D Retiree Drug Subsidy Application Deadline Is Coming Soon
Excerpt: "Sponsors of calendar-year retiree medical plans must submit applications by Oct. 2 to obtain the Medicare Part D retiree drug subsidy (RDS) during 2010. RDS applications with valid initial retiree lists are due 90 days before a plan year begins, although sponsors can request an automatic 30-day extension. Even sponsors that previously received the subsidy must reapply each year. This year, attesting actuaries also must register anew, supplying birth dates and Social Security numbers as well as their American Academy of Actuaries membership numbers." (Mercer LLC)
New Enrollees and High-Income Retirees Will Soon Face Higher Medicare Premiums
Excerpt: "About 75 percent of people will be protected from the premium increase . . . . The remaining 25 percent of Medicare recipients will face larger than normal premium increases because the costs are spread across a smaller share of beneficiaries." (US News & World Report)
The Precarious Promise of Post-Employment Health Benefits
Excerpt: "This article examines the increasingly troubled state of employer-provided health benefits for retirees. The availability of such benefits is a major determinant of both the timing of retirement and the financial security of those who retire. Despite the signal importance of these benefits to current and prospective retirees, employers have been steadily eroding their value and in many cases, eliminating these benefits outright. Such actions are often catastrophic for the retirees affected, especially if they are not yet eligible for Medicare. This article begins by explaining the economic pressures that have precipitated this unfortunate development, including the increasing cost of health care generally." (Social Science Research Network)
[Guidance Overview] MSP Rules Prohibit Terminating Group Health Plan Coverage Based Solely on ESRD Eligibility, Except as Permitted by COBRA
Excerpt: "EBIA Comment: This case reminds us that the rules regarding Medicare eligibility and entitlement (including those for ESRD) are detailed and complex. It highlights that the rule prohibiting termination of group health plan coverage because of ESRD Medicare eligibility or entitlement does not prohibit termination of COBRA when termination of such coverage is expressly permitted (e.g., upon entitlement to Medicare)." (Employee Benefits Institute of America)
Centers for Medicare & Medicaid Services Announcement of Medicare Part D Premium Amounts for 2010
Excerpt: "The national average Part D premium for Medicare prescription drug coverage will reach $31.94 in 2010, up from $30.36 per month in 2009, CMS estimates. Employers applying for the retiree drug subsidy use this figure when determining the actuarial equivalence of their benefits. Part D beneficiaries will pay an average monthly premium of $30 in 2010, up from $28 in 2009. Other 2009 Part D figures released by CMS supply national average monthly bid amounts for stand-alone and Medicare Advantage (MA) plans offering prescription drug benefits, low-income subsidy amounts and MA benchmarks." (Mercer LLC)
[Guidance Overview] Broad Medicare Secondary Payer Reporting Rules Mean Additional Data Collection
Excerpt: "The Medicare Secondary Payer program seeks to ensure that Medicare isn't the primary payer of medical claims for beneficiaries also covered by group health plans. Mandatory reporting to Medicare of most group health plan participants' information began this year. Although insurers and third-party administrators are mainly responsible for the reporting, employers may need to collect some information, such as dependent Social Security numbers, from health plan enrollees. This Update provides an overview of the requirements and information employers may need to collect." (Mercer LLC)
The Implications of Declining Retiree Health Insurance
Excerpt: "Using data from the Health and Retirement Study, this paper examines the potential consequences of eliminating RHI for both pre-Medicare and Medicare-eligible retirees. For younger retirees the likely primary response is to work longer, and we find that number of workers age 55 to 64 would increase by 7 percent, as some of those who have their access to RHI eliminated would work rather than retire. Of those who still choose to retire, most lack any employer-sponsored health insurance option and would need to find an alternative source of coverage or go uninsured. For Medicare beneficiaries over 65, we estimate that about three quarters would replace RHI with another form of supplemental coverage. This shift would slightly reduce total spending and utilization for individuals who choose basic Medicare or a Medicare HMO as opposed to a Medigap plan, but health outcomes would probably be unaffected no matter which supplemental option is chosen." (Center for Retirement Research at Boston College)
[Opinion] U.S. Social Insurance Needs Rethinking
Excerpt: "The U.S. is headed for a fiscal meltdown. Even before Congress began calling for a hugely expensive overhaul of health care, the federal government was a staggering $56 trillion in the hole, in terms of unfunded obligations. That's $184,000 of debt for every American. Even after its tax increases, the House health bill would add an additional $10 trillion in red ink. No wonder foreign investors as well as ordinary Americans are beginning to worry we won't be able to pay our national bills." (Stuart Butler via The Washington Times)
[Guidance Overview] New Audit Guide for Medicare Advantage and Part D Programs Released for Comment
Excerpt: "In its proposed collection and comment request published in the Federal Register on Friday, July 31, 2009, CMS announced the merger of the existing Part C and Part D audit guides into a single Medicare Part C and Part D Universal Audit Guide. Currently available in draft form, the universal audit guide reflects streamlined data elements, uniform language, and omits duplicative data elements as well as previously deleted items. The information collection and comment request also includes a draft audit confirmation letter; minimum documentation requirements for sample case files; and the accompanying 'universe request' for data for Medicare Advantage and Part D Plan audits." (McDermott Will & Emery)
[Guidance Overview] Medicare Reporting Applies to Uninsured Liability Claims: Employers May Be Required to Register
Excerpt: "The Medicare, Medicaid and SCHIP Extension Act of 2007 ('MMSEA') implements new mandatory reporting requirements (referred to as 'Section 111 Reporting') to allow Medicare to identify medical claims where another entity, not Medicare, is responsible for payment pursuant to the Medicare Secondary Payor rules. Most employers, administrators and insurers are aware of how these reporting requirements apply to group health plans, which began July 1, 2009 (except for health reimbursement arrangements which are delayed until 2010). The Section 111 Reporting requirements also apply to workers' compensation claims and to liability insurance (referred to as 'Non-GHP Arrangements'). Registration for Non-GHP Arrangements must be completed by September 30, 2009 and reporting begins in 2010. However, the Section 111 Reporting requirements are structured to incorporate arrangements and situations which employers do not typically view as implicating Medicare. The focus of this Legal Alert is to highlight the impact of the Section 111 Reporting on these arrangements." (Kilpatrick Stockton LLP)
[Guidance Overview] Medicare Secondary Payer Reporting Requirements Spur Requests for Dependent Social Security Numbers (PDF)
3 pages. Excerpt: "The new reporting mandate under the Medicare, Medicaid and SCHIP Extension Act of 2007 will require group health plan 'responsible reporting entities' (RREs) to submit the Social Security numbers of many employees' covered dependents to the CMS coordination of benefits contractor by October 1, 2009. Although employers are generally not RREs, they may be asked by the RRE to help obtain that information." (Buck Consultants)
Medicare Part D Update : Lessons Learned and Unfinished Business
Excerpt: "Enacted in 2003, Medicare's Part D prescription drug benefit reflected an unprecedented and controversial new approach for Medicare, relying exclusively on private plans to provide health coverage and including an unusual gap in coverage. This analysis by Kaiser researchers examines in detail how the new model has worked since its launch almost four years ago. Published as an article in today's New England Journal of Medicine, the analysis by Kaiser vice president Patricia Neuman and principal policy analyst Juliette Cubanski assesses the evidence related to key policy questions arising from the Part D benefit. It also briefly discusses a number of potential policy changes to the Part D benefit that could arise as Congress and the Obama Administration weigh the program's future." (Kaiser Family Foundation)
[Guidance Overview] Recent Legislation and Regulations Require Changes to Health and Welfare Benefit Plans
Excerpt: "Congress and federal regulatory agencies have been busy enacting legislation and proffering guidance which implements many new requirements for group health and welfare benefit plans. Many of the changes will require thoughtful action on the part of administrators and sponsors of group health and welfare benefit plans. This brief outline of current health and welfare compliance developments is not intended to be exhaustive, but rather serves to illustrate the depth and breadth of changes facing plan sponsors now and in the coming months." (Littler Mendelson P.C.)
GAO Testimony: Overview of Approaches to Control Prescription Drug Spending in Federal Programs
June 24, 2009. 16 pages. Testimony given by John E. Dicken, director, health care, before the Subcommittee on Federal Workforce, Postal Service, and the District of Columbia, House Committee on Oversight and Government Reform. (U.S. Government Accountability Office)
Obama To Formally Announce Medicare Drug Costs Cuts Today
Excerpt: "The pharmaceutical industry agreed Saturday to reduce Medicare drug costs as part of health overhaul in an apparent effort to stave off potentially more-burdensome givebacks under the Democrats' health-overhaul plan. Today, President Barack Obama will make a formal announcement about the deal. The Wall Street Journal reports: 'Drug makers on Saturday outlined a proposal to forgo $80 billion in revenue over a decade, largely by covering more of the cost of brand-name prescription drugs under the federal government program for seniors. It would make up part of the $313 billion in government health-spending cuts that President Barack Obama has proposed over a decade to help pay for the overhaul plan.'" (Kaiser Family Foundation)
[Guidance Overview] CMS Update on Mandatory Insurer Reporting User Guide and Other Guidance
Excerpt: "This Capital Checkup summarizes key issues addressed in the updated guidance: New registration deadline for entities reporting only on Health Reimbursement Arrangements (HRAs), What it means for a person to be 'known to be entitled to Medicare'), and CMS's recommended process for collecting Medicare Health Insurance Claim Numbers (HICNs) or Social Security Numbers (SSNs)." (The Segal Group, Inc.)
Savings Needed for Health Expenses in Retirement: An Examination of Persons Ages 55 and 65 in 2009 (PDF)
Pages of 20 pages. Excerpt: "This report updates earlier EBRI research on estimated savings needed to cover health insurance to supplement Medicare and out-of-pocket expenses for health care services in retirement. It finds that men age 65 in 2009 retiring this year will need anywhere from $68,000?$173,000 in savings to cover health insurance premiums and out-of-pocket expenses in retirement if they want a 50?50 chance of being able to have enough money, and $134,000?$378,000 if they prefer a 90 percent chance. With their greater longevity, women will need more: a women retiring at age 65 in 2009 will need anywhere from $98,000?$242,000 in savings to cover health insurance premiums and out-of-pocket expenses inretirement for a 50?50 chance of having enough money, and $164,000?$450,000 for a 90 percent chance." (Employee Benefit Research Institute)
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